Collateral Ligament Vent/ Advice Needed

[kaya842]

My lovely coffin bone problem child was in light work getting into semi regular work (3-4 days a week 30ish min rides mostly w/t with some canter) and came up lame in July. Had a new to me vet out who said it was a case of low heels and long toes (). Spent a few weeks chasing hooves as I thought it was another abscess / coffin bone issue (also no). The new to me vet came out when I wasn’t able to be there. They took not the best rads and said she blocked 80% to her RF heel and they assumed the remaining bit was compensation soreness. Late August after consulting with other vets on the rads and changing her shoeing to an egg bar which improved her 50-60%, I set up time with my normal vet which ended up being mid September as she was out of the country for 2 weeks. She came out and mare did not block out to her heel. She finally blocked sound mid cannon. We did not re-xray anything at that point. We did an ultrasound of nearly the entire RF from knee down with some weirdness (rough edges?) on her collateral but everything else was WNL. Oh vet did say during US there was some fetlock arthritis which has not been seen or DXed via rads before. Vet said the collateral didn’t look bad but could fit given the block and the fact we were 2 months post initial lameness at that point. We started shockwave (3 rounds two weeks apart) and put her on medical paddock turn out + vet said to start talk walking 30 min/ day. We are 3 weeks in and just UGH. I don’t know that I feel the DX is correct. There was never any swelling or heat that I’ve experienced in the past with soft tissue. She seems equally off on hard vs soft ground. I was told by vet that the collateral is not really a big deal (vs a suspensory which was the initial concern), but reading old threads makes me think we shouldn’t even bother trying to come back into work due to her age and other issues. UGH again. Forgot to add that the location was medial just above the fetlock

Does any of this track for a collateral issue? Or is it possible the DX is wrong? Should I bother with rehab trying to get her back into work?

[beowulf]

My gelding had a medial and lateral collateral ligament rupture in his hind fetlock. Like your horse there was almost no swelling. He was also barely lame - but I didn’t like how he moved on it and pushed for rads.

There is hope but I understand given your situation it may feel like another nail for your mare. The prognosis is generally positive when it’s not in the hoof or stifle.

It’s been so long I forget specific details but I remember on ultrasound his ligament looked like shark teeth it was that irregular. I remember I gave him the whole winter off, but on 24/7 turnout. I gave him Platinum Performance CJ on advice of my then-vet, who swears it’s the reason he had such good healing on recheck. (Side note- later a different vet ultrasounded that area and could barely tell there was ever an injury there). I brought him back to work that summer with no complications.

I know I posted about it when it was happening. I’ll see if I can find the threads when I’m off mobile.

Fingers crossed for you. I think what really helped my guy was being out after initial healing.

[beowulf]

Alright, here are my notes about it - I found our original paperwork from the injury.
Rupture of collateral ligament (medial/lateral) on left hind fetlock with avulsion fragments - injury site showed irregular healing suggesting this was a chronic injury. This horse was raced on this, btw.
He was on stall rest late Sept - January, so about three and half months. Vet rechecked/reultrasounded in December and noted a 40-50% improvement in fiber pattern. 40-50% improvement in less than two months.
Stall rest for 3.5 months (late September to January) and then 24/7 turnout in a small medical bay, gradually increasing size every few weeks.
My vet pushed hard for me to find a supplement with ~10,000 mg glucosamine, so I tried Platinum Performance CJ. As I mentioned above, my vet is convinced his robust healing was because of that supplement.
Side note - the reason my vet encouraged the supplement was because once I stalled him all of his legs started stocking up, and the injured leg was hot. I wrapped and Surpassed for the first 2 weeks, but he started getting skin reactions to all the Surpass so I dropped the Surpass. No cold hosing, but I bought a pair of Eskradon Climatex Wraps and wrapped his leg with a frozen pea bag and the Climatex - those wraps are still in my first aid kit and are great for keeping ice packs on a leg.
I pulled all his grain and fed him alfalfa pellets and oats for palability. He got fat. He was so bored, so I picked up clicker training with him.
My vet okayed hand-walking for ~10-15m a day. I taught him to ground-drive during these tack walks as he was quiet.
I was conservative bringing him back to work. I moved him to a different state, and the new vet practice was pleased with his progress on re-check and said start riding him. They said any 6 week conditioning schedule would be fine but I erred on the side of caution. I hacked him for ~5 months., I was lucky and was keeping him at a facility with a large track system, so I would trot and occasionally canter on it. A year from the injury we were w/t/c, albeit no drilling in the ring.

One thing - I am convinced the injury happened because of how bad his racing angles were. So get those feet back under balance, if you can. I noticed he went so much better once my farrier aggressively addressed the NPA from the track. It took a few cycles to get them back to where they needed to be.

That was ten years ago now. He’s had his own subset of injuries and problems, but not on that leg…

I hope that helps, and fingers crossed for an uncomplicated and easy recovery.

[TWH_Girl]

@kaya842

. Oh vet did say during US there was some fetlock arthritis which has not been seen or DXed via rads before.

Is there any chance the fetlock arthritis is actually the issue vs the collateral ligament?

I’m no expert on ligament issues but regenerative therapies like PRP and Prostride seem to help. Along with lots of rest. My one gelding had an MPL strain and we did PRP and 6 months of rest.

[kaya842]

Could be! But she didn’t block out to her fetlock (though blocks are not 100% perfect), rather to her mid cannon. Vet said the shockwave should help both the fetlock and the ligament. We did not do PRP since we caught it late, vet thought it wouldn’t be as helpful as the shockwave. She said we can always circle back to PRP if we want though.

I’m worried that we didn’t catch it early enough. She was out on hilly turnout nearly the entire time she was lame from July to DX in Sept (not being ridden though). She is still pretty dang lame, though is not on any NSAIDs. I know we just got a diagnosis and started treatment less than a month ago but are 3 months or so out from the injury which has me feeling like we should be seeing more improvement.

Regarding her hooves - I’ve read a lot about how collaterals are nearly always related to hooves. I can understand the physics/ mechanics of that for sure. What I’m having trouble with, is that this is the best her hooves have looked (on radiographs not just external appearance) in years. She has a positive NPA and near normal sole depth for the first time in 5? Years. I’m not saying they aren’t still a work in progress but they are SO much better. And yet.

[beowulf]

@kaya842

I’m worried that we didn’t catch it early enough. She was out on hilly turnout nearly the entire time she was lame from July to DX in Sept (not being ridden though). She is still pretty dang lame, though is not on any NSAIDs. I know we just got a diagnosis and started treatment less than a month ago but are 3 months or so out from the injury which has me feeling like we should be seeing more improvement.

Regarding her hooves - I’ve read a lot about how collaterals are nearly always related to hooves. I can understand the physics/ mechanics of that for sure. What I’m having trouble with, is that this is the best her hooves have looked (on radiographs not just external appearance) in years. She has a positive NPA and near normal sole depth for the first time in 5? Years. I’m not saying they aren’t still a work in progress but they are SO much better. And yet.

My gelding was raced on his - so there is hope for your mare.

I feel your pain - sometimes unraveling the lameness onion is a Russian Nesting Doll of surprises. Could be that small tweak for the better upset the apple-cart; when they are functionally uncomfortable they compromise in other areas, which leads to other compensational injuries. Horses just can’t be simple.

Starting with shockwave is a good step. One day at a time.

[SBrentnall]

My gelding had a medial collateral ligament that, according to the MRI, was barely hanging onto the bone. And yet he’d shown 4th level a month before. He just had NQR days, but nothing consistent. Certainly no one would have called him lame.

I was told that even with a year or rehab and intensive shockwave, he only had a 50/50 chance of being sound for trail riding, so I retired him to pasture.

[EventingChase]

Mine had a collateral ligament tear at the fetlock in March this year. He was very, very lame. Pretty much 3 legged, he had to spend 3, maybe 4 months in a split cast in a stall. About partway through that he reinjured it and it felt like starting over again. There were days when I wasn’t sure it was going to be fair to keep trying with him. His saving grace is that he was exceptionally good on stall rest, very settled, very easy so it never seemed like a quality of life issue.

He had 3 rounds of shockwave and gradually over the last 3 months has really come around and is now on full turn out. He is 22 and the goal was always to try and get him pasture sound so he could enjoy retirement.

[kaya842]

I’m glad to hear your boy is feeling better! My girl is a very good patient with the confinement and anything other than orally syringed meds which we don’t need currently. It is tough to see her so uncomfortable for so long. With her age and history, it has crossed my mind about if this is straw that breaks the camels back. I’ve also wondered about a correlation to her Cushings (I swear I’ve read that Cushings and soft tissue injuries are linked), which tests as mild but seems to be more severe than it lets on (or she has other undiagnosed things that led to the infections from hell). I’d love for her to be sound for light riding as the vet says she may be but would be happy with sound in the pasture as well.

[kaya842]

Vet was out today for what was supposed to be the final round of shockwave and the follow up ultrasound. I had messaged her prior to today expressing concern over the continued lameness/ lack of improvement. She noted that the ligament looks better on the ultrasound and shared concern over the lameness. She said with how lame the horse is she would expect to see a hole in something somewhere which isn’t the case at all. We both agreed the collateral may be causing some soreness but isn’t the main culprit and may even be coincidental at this point so discontinue the shockwave for now. Instead, we injected the fetlock as that is the only other clinical finding we have in the area she blocked out to. Pony is in for 2 days with bute then back to limited (medical) turnout. Vet wants to do 2 weeks (after the 2 days of bute) of Equioxx to help with the body soreness that I brought up and she saw as well. Hopefully this fetlock thing gets us moving in the correct direction. I don’t have the funds for an MRI or bone scan and we’ve ultrasounded and radiographed the entire lower limb without any other findings so if this doesn’t help, we will be lost in the dark a bit.

I did get her some SmartGut and Lubrigen (joint) supplements along with some chia seeds (O3) to potentially try to help. I got them at a massive discount (75% off retail) so figured it wouldn’t hurt to see if the joint shop helps with the overall soreness and the gut supp helps with her gut (which isn’t doing terrible but she is an ulcer prone horse who has been lame for a while with NSAIDs about to come on board for a bit so it isn’t unwarranted). Also considering hind shoes as they have helped in the past.

[EventingChase]

I can’t remember where your horse’s injury was, but I can say for mine, whose injury was in the fetlock, I experienced the same thing.

He seemed way too lame for too long for as mild as the injury looked on ultrasound. How my vet explained it to me, is that in that place the collateral ligament really is the stabilizing structure for the joint. Therefore, just a tiny tear or stretch, even if not incredibly painful could cause a huge amount of instability and lameness. She likened it to walking in too big clogs and having that rolling feeling every step.

I hope your horse feels better and gets some relief soon!

[SBrentnall]

Have you had an MRI? My boy’s collateral ligament injury didn’t show on ultrasound, but was clearly just barely still attached on the MRI.

[kaya842]

No, I don’t have funds for an MRI (or bone scan). Where was your horse’s injury located and where did it block out to? The damage we saw on the ultrasound was on the medial side above the fetlock. She blocked out to mid cannon but did not block sound to her hoof. I don’t know what an MRI would pick up in the leg that the ultrasound can’t but I have no experience with MRI.

[SBrentnall]

Mine didn’t block out to a specific area - that’s the problem. The injury was to the right front, and it only showed up on an MRI. All the other lameness exams and tests had been inconclusive.

[kaya842]

Where in the leg was the injury, out of curiosity?

[SBrentnall]

Just checked - it was the LF, not RF. Here’s the MRI report:

FINDINGS

Left forefoot:
The medial collateral ligament of the distal interphalangeal joint is severely disrupted with high signal intensity on PD and STIR sequences. The normal margins are difficult to define. This damage extends diffusely along the entire length of the medial collateral ligament. The mid to proximal portion is most severely affected.

The joint capsule of the distal interphalangeal joint is moderately thickened with moderate synovial proliferation and mild effusion. There is mild osseous proliferation on the dorsal cortex of the middle phalanx at the attachment of the DIP joint capsule and mild periarticular osteophyte formation both on the dorsal and palmar aspect of the joint.

There is slight fraying of the dorsal margin of the deep digital flexor tendon at the level of the proximal recess of the navicular bursa. The bursa does not contain increased fluid. A well-defined, rounded osseous fragment extends off the distal lateral border of the navicular bone. The navicular bone is otherwise within normal limits.

Left fore fetlock:
The dorsal distal aspect of the third metacarpal bone, most predominantly on the medial condyle, is mildly to moderately sclerotic. No associated subchondral bone defects are noted. A small, round well-defined in situ fragment is present on the dorsal medial aspect of the proximal phalanx. No osteoarthritic changes are noted.

CONCLUSIONS

1. Severe extensive fiber tearing and partial rupture of the medial collateral ligament of the distal interphalangeal joint. This is the most significant imaging finding
2. Moderate capsulitis, synovitis and mild osteoarthritis of the distal interphalangeal joint
3. Very mild fraying of the deep digital flexor tendon, likely of low clinical significance
4. Likely incidental distal margin fragmentation of the navicular bone
5. Moderate stress remodeling of the distal third metacarpal bone

[Pennywell_Bay]

Our 1.50 mare had a collateral injury, diagnosed by MRI,though not a rupture. PRP, shockwave, etc. Time off. Slowly rehabbed over 6 months or so. She went back to jumping, but we only did 1 1.50 and then she dropped down to the 1.30 and occasional 1.40 classes. We also have to inject her coffins to keep her happy at the higher levels. Most likely, she will be dropping down to be a school master of some type. But she did have a total recovery. Basically, it was a long, painful to us trying different shoes, finding what hurts etc. We were totally willing to just retire her but seemed to found what keeps her happy “at that height”. 100% if she wasn’t doing the “big jumps” she doesn’t need the maintenance she gets now.

It is extremely frustrating and I am sorry.

[kaya842]

The plot thickens, as it nearly always does. The farriers came out to reset her and put testers on her and found that she’s incredibly sore on her medial heel. Farrier said it could be either an abscess or soreness from the wedges putting too much pressure on her heel(s). We took the wedge pads out in favor of a leather rim pad and kept the egg bars. She does seem sounder after the fetlock injection but obviously not 100%. Hoping for no abscess and that the wedges coming off is all she needs to clear up the heel pain.

[TWH_Girl]

Hope the fetlock injection helps. Honestly, an abscess would be pretty welcomed over some of the other options!